Ten years ago, the Centers for Disease Control listed the top 10 achievements of public health in the 20th century -- among them, family planning, control of infectious disease, and vaccinations. These achievements vastly improved our quality of life, resulting in an increase in life expectancy, worldwide reduction in infant and child mortality, and the elimination or reduction of many communicable diseases.

Following President Obama’s historic address to the nation, America is poised for the first dramatic public health achievement of the 21st century.

What makes this moment truly life-changing in every sense of the word is that, for the first time, more women and their families will have coverage than ever before in our nation’s history.

However, if a new national health plan is to fulfill the goal of correcting our fragmented health system and improving America’s health, then it must address the specific health needs of women. That’s why earlier this year, I and a group of medical and public health colleagues contributed to a scientific, data-driven report stating that reproductive health should be an essential part of any national health plan. Our statement was endorsed by 39 deans of schools of public health.

According to the report, issued under the aegis of Columbia University’s Mailman School of Public Health, “a well-woman standard of care -- one that includes access to comprehensive care and services essential to reproductive health -- will ensure that women can attain good health, maintain it through their reproductive years and age well.”

Put simply: without making women’s reproductive health a central component of health care reform, we will not have real reform in the 21st century.

The scientific data point to the compelling need to improve the reproductive health of all Americans. Rates of maternal and infant mortality, low birth weight, unintended pregnancy and sexually transmitted infections are much too high for a nation that is rich in resources and technical competence. Moreover, health problems are concentrated among disadvantaged groups, and these disparate rates have stagnated or worsened over the past three decades.

The good news is that the proposals currently being considered in the House and Senate contain many of the critical elements that will help us address these problems. For the first time, women will be able to participate in a health care system in which:

Maternity and reproductive health will be part of a basic care package.

Women won’t be charged more because of their gender.

An affordability provision will subsidize those who can’t afford insurance.

Out-of-pocket costs will be capped so that families don’t go bankrupt.

No American can be denied health coverage because of a pre-existing medical condition, including breast cancer, pregnancy or evidence of “uninsurability” such as being a victim of domestic violence.

Key preventative tests, like mammograms and pap smears, will be included in basic care.

The reforms currently on the horizon are significant not just for women but also for their families, because women act as gatekeepers for the health care that their children, spouses or parents receive. According to the Department of Labor, women make approximately 80 percent of all family health care decisions. But until now, these gatekeepers have all too often been denied the keys to the health care kingdom.

Nearly one-quarter of all women depend on coverage through their husbands’ employment, leaving them vulnerable to the loss of coverage if divorced or widowed, or if their husbands lose their jobs. Recent years have seen an overall decline in health insurance coverage for women. In 2006, 10 percent of American women received coverage through Medicaid, while 18 percent of women were completely uninsured.

For all of these women, including the 21 million American women and girls currently without health insurance, change cannot come soon enough.

As the president said in his speech, health care reform is not about politics -- it is about shaping the future. But in order to bring about that future, we must show what is at stake and why it is in everyone’s interest to demand coverage that recognizes women’s basic needs and is truly health care, not just sick care.

Without these critical changes, our current system may well top the list of the biggest health care disasters of the 21st century.-----------------------------------------------------------------------------Dr. Laube is Professor of Obstetrics and Gynecology at the University of Wisconsin and Past President of the American College of Obstetricians and Gynecologists.-----------------------------------------------------------------------------Copyright (C) 2009 by the Wisconsin Forum. 10/09

Following the close of the 2008 legislative session, and in preparation for a special legislative session on health care, New Mexico Youth Organized (NMYO) and Southwest Organizing Project (SWOP) distributed mailers to the constituents of six legislators. The mailers informed constituents about how their legislators were voting on critical issues and provided information about the source of contributions their legislators were receiving from special interests. Believing this to be political campaign intervention, Secretary Mary Herrera, acting on the advice of Attorney General Gary King, ordered the nonprofits to register as political action committees (PACs). A lawsuit disputing the claim quickly followed.

Recently, Judge Judith Herrera issued an important federal court decision in this closely watched case. In her decision, Judge Herrera sided with decades of legal precedent, and the First Amendment to the U.S. Constitution. Free speech is a value that all of us hold sacred. The implications of having nonprofits, whose primary purpose is not the election or defeat of candidates, register as PACs for simply speaking out about an issue are chilling. If nonprofits were forced to register as PACs, it would severely restrict the ability of thousands of organizations across New Mexico to serve their communities. Perhaps most importantly, it would leave critical voices unheard.

Most people are familiar with the services that nonprofit organizations provide to vulnerable people throughout our state. But the work of nonprofits often goes beyond service provision and extends to advocacy. If a family is homeless, it’s important to provide that family with shelter. At the same time, we must address the causes of homelessness if there is any hope for an America where decent affordable housing is available in all of our communities. That work is advocacy. Similarly, if someone contracts cancer due to exposure to second-hand smoke, providing that person with treatment and perhaps hospice care is essential. But getting to the root of the problem at a policy level will help save lives. That takes advocacy.

Another crucial component of nonprofit advocacy is accountability. Holding our public officials accountable to the needs of their constituents is a core function for nonprofit organizations. Stopping short of criticizing an elected official, simply because that official will stand for election at some point in the future, undermines the essence of our democratic process.

Our elected leaders should be working for all of us, vulnerable communities included. When they do not, nonprofits have a responsibility to point it out. Can you imagine a policy debate in which only corporate interests get to provide input? New Mexicans across the state would get the short end of the stick if they did not have nonprofits working to make sure their voices are heard and their interests accounted for.

Nonprofit organizations also meet with elected leaders to share the complex information, research and experience that is critical to public policy decisionmaking. Issues that affect our communities, like affordable housing, poverty, health care, and education are given greater attention because of the hard work of nonprofits. Absent that role effectively executed, communities that have a huge stake in the outcomes would lose a voice in the policy making process.

In a study of just 14 nonprofits in New Mexico that was completed by the National Committee For Responsible Philanthropy late last year, the researchers documented that the total dollar amount of benefits accruing to the groups’ constituencies and the broader public in the five-year period studied was more than $2.6 billion. Additionally, they found that for every $1 invested in the 14 groups for advocacy and organizing ($16.6 million total), the groups garnered more than $157 in benefits for New Mexico communities. Thus, the return on investment and economic stimulus of organizing and advocacy by nonprofits in New Mexico is inarguably significant to our state's wellbeing.

There's a story going around that's so scary it ought to be told only in a whisper:

If Colorado tries to untangle the conflicts in its budget, it will end up like...California.

No self-respecting state would want that. The massive budget cuts, the IOUs, the celebrity governor autographing government-surplus sale items...yikes! Just the thought makes your blood curdle.

The "change makes us California" story is intended to scare us, but like many good tales, it's blatantly untrue. Budget reforms will not transform us into the Golden State. Almost the opposite is true. In many ways, Colorado is already like California, and if we don't change, more California-type problems are likely.

Opponents of budget reform have peddled the Colorado-to-California scare tactic for years. This summer, the Independence Institute's Barry Poulson repeated it to Colorado's Long-term Fiscal Stability Commission. Speaking about Colorado's ongoing reform efforts, Poulson warned that "if these trends continue, the outcome in Colorado will be similar to that in California."

Poulson supported his ominous assertion by comparing Colorado to California of the 1980s. That's when California voters modified their GANN amendment, a constitutional provision similar to our own TABOR. After that, the story goes, California spiraled into a free-spending budget morass – a state that people and businesses were eager to leave. Surely a similar nightmare would befall Colorado, Poulson intimated.

The comparison is simplistic and false. It ignores meaningful differences between the two states. California boasts one of the world's 10 largest economies, and a general fund budget roughly 13 times the size of Colorado's. California state services support nearly 38 million people, compared to the 4.9 million here.

California's main problem is its requirement for a two-thirds "supermajority" vote by its legislature to pass fiscal measures. This provision allows individual lawmakers to hold the budget hostage each year and makes it almost impossible to pass anything on time. The result is an annual budget impasse and the perception that California is running amok. Stunningly, many in the Colorado-to-California crowd have called for a similar supermajority rule here.

It's also noteworthy that California's GANN changes did not lead to runaway taxes, stagnant growth and people fleeing the state. California's nonpartisan Legislative Analyst’s Office reports that California tax rates, though slightly higher than the national average, are comparable to tax rates in the western region and in other large states. Many corporate powerhouses are located in California, and the state experienced sustained economic growth in the 1990s and early 2000s. Although its growth has slowed along with the rest of the country, California's population continues to climb.

Unfortunately, the "change makes us California" story overshadows the real threat. Colorado's lawmakers are already hamstrung by many of the budget conditions afflicting California. Look at the similarities:

Both states limit residential property taxes. Over time, that's reduced local revenues and shifted much of the public education costs to the states' budgets.

Voters in both states passed constitutional budget formulas that guaranteed ever-increasing amounts for K-12 education. That means K-12 funding must grow even when state revenues drop.

Both states are experiencing fiscal pressure from other programs that can't be cut, notably corrections and federally mandated Medicaid. Roughly 73 percent of their general fund budgets are consumed by K-12 education, Medicaid and corrections.

Although we don't have a supermajority requirement, Colorado's voter-approval requirement in TABOR has a similar effect -- revenue increases to pay for our growing costs aren't impossible, but they are highly improbable.

Those restrictions are creating significant fiscal headaches. This year, the economic downturn forced Colorado lawmakers to close a $1.8 billion budget shortfall. With limited options, the resulting cuts hurt -- layoffs and furloughs for state employees, a closed nursing home and a shutdown of a prison project are examples. And all indications are that next year will be just as painful, if not more so.

The lesson is this: Don't be scared by wild stories that budget reform will turn Colorado into California. It won't. But inaction might cause budget paralysis that's just as bad, and that's what's truly worrisome.-----------------------------------------------------------------------------Sundeen is a senior policy analyst and general counsel for the Bell Policy Center, a nonprofit, nonpartisan policy research center in Denver.-----------------------------------------------------------------------------Copyright (C) 2009 by the Colorado Editorial Forum. 10/09

The financial, economic and environmental crises are alarm signals to the world, and particularly to us in the U.S. Acting on the basis of a fragmented worldview while globalization magnified and quickened that worldview’s effects, we rushed into unsustainable and destructive practices. On the other hand, we now have an opportunity to build the foundation for an American Renaissance. Extrapolating from Peter Senge’s learning organizations, “where people continually expand their capacity to create the results they truly desire,” the U.S. can shift to a paradigm of a learning global nation.

Our financial and economic formulas functioned well within the nation-state paradigm for most in developed countries and some in developing countries; the marginalized experienced totally different results, but couldn't convey their dissatisfaction effectively. Thus, 4 percent of the world's population could consume a quarter of global resources, enjoy a continuously improving material quality of life and disregard global consequences as externalities because no one of significance seemed to complain. Indeed, many developing nations still think they should enjoy the same increasing affluence with little accountability. Once 17 percent of the world's population, consuming at the American rate, surpasses 100 percent of global resources, what should the rest do?

Because it seemed we had devised a flawless machine -- the intelligent market -- and had reached what Francis Fukuyama termed “the end of history,” the rush to expand use of our unrestrained growth formulas finally boomeranged.

The crises encompass international relations and the environment. The buffer of delayed effects of our actions and the resilience of humanity and nature allowed us to be indifferent to the impact we were having on each other and the environment. This buffer is no longer capable of shielding us in the smaller world of globalization.

Yet, we are not letting go of the nation-state mindset and other cherished but less reputable notions, such as the mantras used to manipulate the public -- “You can have it all, looking out for No. 1, and winning is the only thing,” which are alive and well. Economist Paul Krugman recently wrote that we are unable to give up the also simplistic “ideology that says government intervention is always bad, and leaving the private sector to its own devices is always good.” Consequently, dilemmas are resurfacing: excessive compensation to executives in bailed-out institutions, new Wall Street grand ideas for securitization, trade protectionism proposals, a militarized wall between the U.S. and its free-trade partner and neighbor, credit cards being used for rent and food at exorbitant rates of interest, and a Yale professor in the Washington Post calling for American corporations to continue striving for “the highest profits in history.”

The solutions to dilemmas the nation and world face are all around us, but we cannot see them because we retain dysfunctional either/or mindsets. We need to acknowledge their incongruence and shift to a paradigm more in keeping with the reality of globalization -- both its powerful forces and its definition of our limitations. We need to see, think and act as global nations instead of nation-states…as citizens of the world instead of exclusively national citizens.

Secretary of the Treasury Geithner appeared on CNN and repeatedly told interviewer Zakaria that he was glad other nations, particularly China, have accepted the “imperative” of consuming more and saving less. This isn't a paradigm shift; it's an expansion of a culture of excessive consumption that the U.S. and others have been following for years and which has been recently identified by a few prestigious and courageous economists as the culprit behind the financial and economic crises.

Geithner also claimed that our government has implemented a strategy in response to the crises. TARP and the stimulus package do not constitute a strategy; they are tactical corrective measures to regain liquidity and trust. Some economists had delayed judgment so as to not exacerbate the public’s anxiety, expecting that there was an undisclosed strategy behind those measures. Now it appears that a new strategy might not exist. Reactivating the economy with a capital infusion is not dealing with fundamental problems brought to light by the crises; without a long-term and new strategy, it is creating false long-term expectations.

Only a new paradigm can lead us to a new strategy; yet a new vision does not have to reject our identity. This new paradigm can complement the context of globalization and foundational principles of this nation: educated democratic participation; association and collaboration; accountability; frugality; modesty; honesty; and “a decent respect for the opinions of mankind.” The latter will help us become a learning global nation, which will allow us to learn from Japan’s and China’s dominant linkage of finance to the real economy, from the banking practices of Canada to better regulate our financial system, from Norway’s medical insurance coverage of its citizens treated in Denmark to expand Medicare coverage to selected Mexican clinics for the million Americans now living in Mexico and the many more who would move there if coverage were available, from the nations who excel in moderation and moral values.

Yes, let us continue giving credit to American innovation and individualism. But let us balance them with wisdom and the overarching goal of the common good. We've demonstrated capacity to unleash powerful forces; now we need to “see” sufficiently and to learn how to manage these. The complexity and paradoxes of a globalized reality call for a paradigm of complementarity --seeing through this prism, we can create the results we truly desire!-----------------------------------------------------------------------------Garcia is a consultant on international trade and investment and on intercultural communications.-----------------------------------------------------------------------------Copyright (C) 2009 by the American Forum. 10/09

When the Iowa Department of Human Rights awarded the 2009 Cristine Wilson Medal for Equality and Justice to Sister Mary McCauley for her defense of community after the Postville raid, she humbly said: “It is our duty to work for equality and justice.”

These are just the latest of this brave woman’s history-bound words in a ministry that started the day of the raid, May 12, 2008, when she summoned Father Paul Ouderkirk out of retirement with a phone call: “Father, we need a collar down here.” Ever since, she has been a pillar of strength and inspiration to many in Postville and across the country.

When I was inside Waterloo’s National Cattle Congress, interpreting the misguided prosecutions and watching authorities sworn to uphold the Constitution deny it to 389 ragged workers in chains and tears, I was reminded of Orwell’s Animal Farm: All are equal under the law, “but some are more equal than others.” I was dumbfounded, confused, and afraid, with no one to turn to for guidance on equality and justice. That is when I found Sister Mary.

It was the evening of May 13th. Eager to find out what was happening “on the outside,” I found an Internet video clip of Sister Mary, surrounded by trembling women and children, describing the tragedy. “This shattered us,” she said firmly. “Hundreds of families were torn apart by this raid. The humanitarian impact is obvious to anyone in Postville. The economic impact will soon be evident.” I had found a moral compass.

Sister Mary had told the world what was happening in Postville. The ball was in my court: Shame on me, if I didn’t follow her lead and tell what happened on the inside. After I published my essay on the Waterloo prosecutions, she wrote to thank me. Since then we have corresponded and spoken regularly about equality and justice.

Those who do not know her might think she is a passionate advocate. Yet it is not passion or politics that drives her, but duty, serene faith, sheer humanity, and intelligence. Sister Mary is the voice of reason and sanity in times of extremism and crisis. Hundreds of gendarmes in trucks and helicopters storm the town; wailing children, destitute mothers, hungry workers beg for shelter; community volunteers seek her direction; and Sister Mary delivers, calm amid the storm. Her composure and kindness are a source of strength for others.

I joined the Postville relief effort part-time from afar and found it heart-wrenching, even in small doses. I wondered over the months how those in Postville could cope day-to-day with so much misery. I understood when I met Sister Mary last October at Luther College and at the Postville anniversary vigil in May. A year of stress and sorrow had taken a visible toll on many of the relief workers, but Sister Mary was in for the long run.

Day in and day out they reckoned with the traumatized children; the desperate women with ankle monitors and deformed hands from 24,000 daily cuts on the meatpacking line; the starving families in Guatemala and Mexico, the workers languishing in jail, the persistent fear and despair, the bills, the legal and medical needs, the empty food pantry, the crumbling economy of the town, the homeless, and the long, cold, heartless winter of 2008. And they are still at it. Sister Mary’s work is far from over.

Almost a year and a half later, among many other problems, there are still women with electronic shackles and ankle sores, suffering from depression and post-traumatic stress. Sister Mary accepted the Human Rights Medal on their behalf.

In contrast with Mary McCauley’s leadership and grandeur stands the federal government’s callous disregard for the local community, both migrant and Iowan. Postville’s is the most egregious example of reckless enforcement, abuse of process, and domestic interventionism in American history. Yet no investigation, acceptance of responsibility, or assistance of any kind has been forthcoming. Instead, a follower, in this untoward prosecutorial debacle, is being promoted to a position of leadership as Northern Iowa’s U.S. Attorney.

The Cristine Wilson Medal, reserved for true leaders, is a fitting preview of how history will regard these events and their participants. It symbolizes the inspiring strength of the individual, and shows the world that in the end, big government was no match for the little nun from Iowa.--------------------------------------------------------------------------------Camayd-Freixas, is a professor of modern languages at Florida International University.--------------------------------------------------------------------------------Copyright (C) 2009 by the Iowa Forum. 10/09

Too much heat and too little light are being generated right now inside the Washington, DC Beltway on the issue of global warming. Some electric utilities and allies in the coal and nuclear industries claim that only coal or nuclear reactors can meet future energy needs and combat global climate change. They say there is no other way.

However, beyond the Beltway there is clear evidence that there is another way. There is a prosperous new direction – without using more polluting coal or building more expensive, dangerous nuclear reactors.

Quietly, but steadily, one major U.S. utility, California’s Sacramento Municipal Utility District (SMUD), has spent the last 20 years demonstrating that this “third way” powers economic growth, is easier on the family pocketbook, and slashes air pollution.

Despite its odd sounding acronym, SMUD’s success – now spanning two decades – is a model for other cities, states and indeed, for Congress. SMUD’s path to success began in 1989 when Sacramento voters closed the problem-plagued and expensive Rancho Seco nuclear reactor. SMUD's citizen leaders then embarked on an ambitious and remarkably productive, utility-led, energy efficiency and green energy initiative.

Since the vote to shutdown their troubled reactor, Sacramento’s industries, commercial businesses, residents, and nonprofit institutions, have benefited from consistently lower electric rates than California’s major utilities. Close collaboration with customers is a key to SMUD’s comprehensive energy efficiency programs and renewable energy development, ranging from detailed audits of industrial facilities to incentives for miserly refrigerators and compact light bulbs. SMUD even enabled local manufacturers to “co-generate” electricity for the community together with the steam needed for their industrial processes.

Moody’s Investor Service, Wall Street’s fiscal watchdog of U.S. utility performance, rates SMUD higher than or equal to other U.S. utilities that operate nuclear reactors. In June, Moody’s warned that: “The likelihood that Moody’s will take a more negative rating position for most issuers actively seeking to build new nuclear generation is increasing.”

On the cost side of the energy equation, a new, comprehensive academic report from Vermont Law School (VLS) on the prospective economics of new reactors underscores Moody’s wariness of embracing a new generation of reactors. The study, conducted by Dr. Mark Cooper, found that efficiency and renewable energy cost estimates average 6 cents per kilowatt-hour, while the cost of electricity from new nuclear reactors is estimated in the range of 12 to 20 cents per kilowatt-hour. VLS’s analysis concludes that, “the additional cost of building 100 new reactors, instead of pursuing a least cost efficiency-renewable strategy, would be in the range of $1.9-$4.1 trillion over the life of the reactors.”

Congress and the American people have heard this story before – promises that nuclear power is a solution to America’s energy needs. In fact, nuclear power continues to be a fiscal black hole; looming as a fool’s gold solution to the growing real threat posed by global climate change.

Many states “get it” and are now implementing SMUD-type programs. More than two dozen states have legislated or passed referenda requiring that utilities provide a specific percentage – typically ranging between 10-30 percent of their electricity supply – to be generated by sustainable energy resources by a certain date. Nearly 1,000 mayors of cities like Denver, Chicago, Portland, Austin, and Salt Lake City, representing tens of millions of Americans, have signed the Mayor’s Initiative on Climate Change, pledging to use sustainable energy resources to power their jurisdictions to prosperity.

Nevertheless, Beltway cheerleaders for the nuclear and coal industries are trying to force us, the taxpayers, to give away tens of billions more in shaky loan guarantees. This scheme shifts responsibility for failed nuclear projects onto the backs of the American families and businesses -- despite the conclusion of the Congressional Budget Office that 50 percent of such nuclear reactor loans will likely default.

The nuclear industry and their lobbyists want us to take the risk while they pocket the profits. New nuclear reactors would lead us deeper into national financial debt, and weaken our economy.

Congress must look outside the Beltway and adopt practical and profitable solutions like Sacramento did 20 years ago. It’s time to make energy efficiency, wind, geothermal, biomass, and solar power the cornerstone of America’s energy future.--------------------------------------------------------------------------------Smeloff is a developer of utility-scale solar projects for SunPower Corporation and the former president of the Sacramento Municipal Utility District. Denman is an energy policy consultant and the former executive director of the national sustainable energy advocacy coalition, the Safe Energy Communication Council.-------------------------------------------------------------------------------Copyright (C) 2009 by the American Forum. 10/09

In another life, I was a public school teacher. English, math and eventually “Skills for Adolescence” were the subjects that consumed my days along with an average of 140 seventh graders.

Every day I worked hard to meet the needs of my students in “inner-city” public schools in Mississippi. I remember the tears of the student who came to me to discuss her pregnancy and how she was going to tell her parents and whether she should get married at 13 years of age.

That year we started a “Peer Ears” program, a peer counseling program, and the next year we started survival skills classes called “Skills for Adolescence.” Too many pregnancies and too many sexually-transmitted diseases forced our school district to incorporate classes to educate our students about their life decisions.

Reading the Centers for Disease Control and Prevention (CDC) report on the sexual and reproductive health of young people was depressing. So little progress has been made here! Twenty years ago several concerned Mississippians formed a statewide coalition to work with the legislature to ensure a comprehensive K-12 health education curriculum, but we still do not have even a pilot program offering students sex education, despite attempts to institute such a program in the 2009 legislative session.

The CDC reports that Mississippi is still among the top states in the nation in the spread of HIV and AIDS among pre-teens. We also have the highest birth rate in the nation for mothers ages 10-14 and 15-17, and have seen a spike in sexually-transmitted diseases. Several government studies have confirmed that about 60 percent of Mississippi high school students are sexually active, but most do not use birth control. The statistics are heart-rending and constitute a moral mandate for action by the leadership of this state.

Mississippi can change such statistics, but like every problem, leaders must step up, understand the issues, look at possible curriculums, get educated and educate our citizens and our youth.

In all my years in public service, I have always been more interested in the opinions of folks in the field rather than critics on the sidelines. I ask the state legislature, the Governor, and the Lieutenant Governor to once more convene a working group focused on comprehensive sex education. This group should include educators, parents, students, social workers and health professionals who deal with youth to ensure that people on the frontlines of teen pregnancy and HIV/AIDS prevention are at the planning table. There are models from other states, like the F.L.A.S.H. program in Washington State, which can be considered.

Young people in Mississippi make tough decisions every day. We can’t be with them all the time, but we can increase their ability to make informed, responsible decisions by giving them the information they need. Comprehensive sex education delays sexual activity and promotes healthier life choices, according to a review of research on the subject by the National Campaign to Prevent Teen Pregnancy.

It is time to set aside emotions and focus on filling the educational gap that jeopardizes the future of so many of our youth. We need a model program that can be set in place across the state. Our young people are counting on us; their health and their future are at stake.--------------------------------------------------------------------Kelly is the recently retired executive director of the Mississippi Commission for Volunteer Service.--------------------------------------------------------------------Copyright (C) 2009 by the Mississippi Forum 10/09

“I don’t need maternity care.” Sen. Jon Kyl (R-AZ) lobbed this comment against Sen. Debbie Stabenow’s (D-MI) efforts to guarantee maternity coverage as a basic benefit in health care reform. “Your mom probably did,” Stabenow famously shot back. That exchange and the wave of support that followed for Stabenow’s proposals illustrates how out of step Kyl is with a huge majority of Americans, including those in his own party.

Voters across the political spectrum are almost universal in their support for making maternity care an essential health insurance benefit through health care reform, according to a new poll conducted by Mark Mellman and commissioned by the Communications Consortium Media Center and the Women Donors Network. Fully 86 percent of voters strongly support a guaranteed maternity care benefit, and 95 percent believe that women should have the right to decide when to have a child, where to give birth and the health care provider who will attend their birth.

At Childbirth Connection, a 91-year-old national organization advocating high quality, evidence-based maternity care, we are not surprised by these results. We’ve known for years that rapid gains in the quality, value and cost of maternity care are well within reach. Health care reform is our opportunity to ensure that all women and babies get higher quality care with better results, and savings from following best practices can be put toward providing coverage for all.

It’s a fact: Maternity care is an essential component of women’s health care across their lifespan, and it represents a major segment of the health industry. Eighty-five percent of all women give birth, and childbirth is the No. 1 reason for hospitalization. With 4.3 million births per year, maternal and newborn charges are the runaway leader in hospital costs – topping $86 billion in 2006. Employers and private insurers pay for 49 percent of all births, and taxpayers pay for 43 percent. Although the U.S. spends more on health care than other developed nations, our performance lags way behind other countries on quality indicators including low birthweight, prematurity, and maternal death rates. According to the United Nations, 40 other countries have lower maternal death rates.

While the vast majority of childbearing women and their babies are healthy and at low risk, the current style of maternity care is procedure-intensive, costly, and entails unnecessary risk, including elective induction and cesarean surgery. Proven practices that are generally safer and cheaper are underutilized, including continuous support during labor, smoking cessation programs and breastfeeding.

Most Americans agree that access to care must be broadened, quality and value improved and costs reduced. These are achievable goals for maternity care today by simply putting into practice what we already know is good for women and babies from comparative effectiveness research. Many provisions of the health care reform measures passed by committees in Congress are a good first step toward better maternity care in this country, and by extension, better care for all Americans. Key provisions include:

prohibiting insurers from excluding pregnancy as a pre-existing condition and using past birth experiences (e.g., cesarean section) to justify ineligibility and higher premiums;

offering incentives to maternity care providers under Medicaid to care for underserved women and their families.

These proposals are geared toward bringing about the rapid gains in coverage, quality, value and cost of maternity care, improved maternal and newborn outcomes, and reduced health care costs overall. They are both cost-effective and compassionate.

America’s women and families are expecting real health care reform. Now it’s time for Congress to deliver.-----------------------------------------------------------------------------Corry is the executive director of Childbirth Connection.-----------------------------------------------------------------------------Copyright (C) 2009 by the American Forum. 10/09

As a midwife in Pittsburgh’s Jewish community during the late 19th and early 20th centuries, my great-great-grandmother Hannah Sandusky brought many healthy children into the world despite the high maternal and infant mortality rates of the time.

I can’t help but wonder what “Bubbe” Hannah – as she was known to all – would make of the fact that today, some 150 years later, the U.S. ranks 42nd globally in maternal mortality rates, the highest among industrialized countries. Maternal mortality is a key indicator of health worldwide and reflects the ability of women to secure not only pregnancy-related services but also other health care services.

The pending reform of the American health care system recognizes this simple equation, creating -- for the first time ever -- a seamless, lifelong continuum of care for women.

Women will be able to participate in a health care system in which they won’t be charged up to 45 percent more than men for identical coverage, and maternity and reproductive health will be part of a basic care package.

That’s good news for the more than 62 million American women now in their reproductive years. The average woman wants two children, so she will spend five years of her life trying to become pregnant, being pregnant and recovering from pregnancy, and three decades trying to avoid pregnancy.

That means pregnancy-related care alone is not enough. Health education, prenatal care, family planning and medical care should all be integrated to help women attain good health in their youth, maintain it through their reproductive years, and age well. These factors are so critical to the health of America that the deans of 39 of America’s 50 schools of public health have endorsed a scientific, data-driven report urging that women’s health needs be treated as a top priority.

According to the report, “The evidence shows that reproductive health care is essential to women’s health. If national health reform is to fulfill the goal of correcting our fragmented health system to improve America’s health, it must address the specific health needs of women.”

As these experts understand, taking care of women really means taking care of everyone, because women have a major stake in decisions about health care for their entire families, and they often play a significant role in the health care that their children, spouses or parents receive.

In a recent speech at the White House, First Lady Michelle Obama affirmed this fact, noting that eight in 10 mothers report they are the ones responsible for choosing their children's doctors, and more than 10 percent of women in this country are caring for a sick or elderly relative.

“Being part of the sandwich generation, raising kids while caring for sick or elderly parents, that's just not a work-family balance issue anymore... it is a health care issue,” Mrs. Obama said. “If we want to ensure women have opportunities that they deserve, if we want women to be able to care for their families and pursue things they could never imagine, then we have to reform the system."

The First Lady is right. By ensuring coverage of prevention and basic health services such as maternity benefits, the proposed reforms will create a system that provides not just “sick care” but true health care for women and ultimately for all citizens of our nation.

Bubbe Hannah may not be here to see it, but the many descendants of the children she brought into the world will certainly benefit from this momentous change. And the many generations of children to come will grow up knowing that health care is a basic human right, not a privilege.-----------------------------------------------------------------------------Raphael is a member of the Women Donors Network and involved with the Moving Forward Initiative.-----------------------------------------------------------------------------Copyright (C) 2009 by the American Forum. 10/09

Hard economic times have spurred an explosion in home gardens with more people realizing that food does not begin and end in the supermarket. This increase in food awareness, coupled with recent food recalls, has brought increased attention to issues of food safety and farm policy.

Unfortunately, recent proposals fail to take into account the issues underpinning the food safety problems faced by this country.

Congress is seeking to enhance federal oversight of the production of food, thereby increasing food safety. To that end, all food producers would be subject to the same stringent regulations, regardless of their size. The local farmer and his organic or all-natural tomatoes will be treated with the same suspicion as produce from massive industrial “farms” which grow and process enormous amounts of food at unnaturally high rates, bolstered by synthetic fertilizers and genetically modified seed.

Similarly, small ranches where cattle graze on open fields of grass and are slaughtered one or two at a time in local abattoirs would be subject to the same requirements as the giant meat packing companies whose relentless “protein” production requires that they pump their cattle full of growth hormones and steroids, and dose them with antibiotics to combat the dangerous effects of a grain-based diet on the stomachs of animals designed to eat grasses.

The push for food safety ignores the real and important differences between modes of production. In regulating this way, we stand the very real chance of forcing small, sustainable and responsible food producers out of business. The increased cost in both time and money of complying with unnecessarily stringent regulations would be too great to allow many mom-and-pop operations to continue. The answer to our food safety problems though is not to regulate to the lowest common denominator but to raise the standard to which all our food producers are held.

Furthermore, these new food safety efforts demonstrate the flawed mindset with which we approach our food. We have been raised to fear our food and to suspect that items available at the grocery store may be contaminated with deadly bacteria or toxins. We have been taught to overcook meats, and wash vegetables in specially formulated vegetable wash--available in convenient spray bottles. Sadly, under the current industrial mode of food production, such fear is sometimes warranted. We have come to think of food recalls as a part of modern life. Industrial food producers would like us to think food is something too dangerous to be left to small time growers to produce.

The truth is that these problems exist in large part not in spite of the best efforts of industrial food producers, but precisely because of them. Large meat companies race to fatten their cattle for slaughter by feeding them corn, which also encourages the development of a dangerous strain of E. Coli bacteria that sickens those who ingest it.

Similarly, in vegetable production, mono-cropping, the practice of growing large amounts of a single crop in one place, can attract large numbers of pests. Farmers then spray toxic, petroleum-based pesticides, killing not just the pests but all insects in the area. Without beneficial insects, crop pollination and biological pest control becomes much more difficult if not impossible. We become the victims of our own avarice, sickening our animals and our farm fields as well as ourselves in the push for bigger, faster and cheaper supplies of food.

Rather than pushing for stricter oversight of small-scale beef producers, we should eliminate the government corn subsidy, which makes corn-feeding cattle economical. Instead of more testing for pathogens, we need a system by which foodstuffs are raised in a responsible and sustainable way that keeps them free of dangerous pathogens to begin with. When was the last time you heard about a small, organic farmer recalling the produce he sold at the farmer’s market?

Instead of “modernized” regulation and the resulting increased centralization of food production, we need a decentralized, sustainable model of agriculture that emphasizes safe, clean and responsible food production. Rather than a handful of large industrial “farms” producing our nation’s food, we should promote thousands of locally producing small farms. Small, local and sustainable food producers are already supplying many thousands of customers through local farmers markets, co-ops, buying groups or Community Supported Agriculture. Buying food from the person who grew or raised it a few miles down the road assures the freshness and cleanliness that industrially-produced grocery store food will never have, no matter how much government regulation and oversight we impose.-------------------------------------------------------------------------------Mattera is a sausage-maker and an advocate of local and sustainable food systems.-------------------------------------------------------------------------------Copyright (C) 2009 by the Virginia Forum. 10/09

Year in and year out, healthcare costs go up faster than the rate of inflation. This year, we will spend more than $2.5 trillion on healthcare in the U.S., which is over $8,100 per person. Even at that, more than 35 million of our fellow citizens are left without regular healthcare coverage through insurance or a government program.

Health insurers serve as a convenient target, getting criticized for denying care to those that need it most, creating too much red-tape for doctors and other providers, and for diverting too much of our insurance dollars to administrative overhead, profits, executive compensation, and lobbying. But since most insurers pay out 75 to 85 percent of premium dollars in medical reimbursements, the direct savings from taking them entirely out of the system is no more than 25 percent.

If like me, you are concerned not just with the availability and quality of healthcare, but also its affordability, then it is important to understand that we have to look beyond insurance reform and coverage mandates. We must also look also at our healthcare industries, by which I mean doctors, hospitals, pharmaceutical companies, and so forth. Most importantly, we have to look at -- and fundamentally change -- the current dynamic in which employers, insurers, healthcare providers, and last (and sometimes least) patients come together to deliver and pay for our medical care.

Neither health insurance nor the healthcare industries exhibit the benefits we expect from effective marketplace competition. As BusinessWeek Magazine recently reported, most health insurance markets in the U.S. are effectively monopolies or duopolies (one or two companies control the vast majority of market share). They found the same thing for hospitals. Insurance companies are unwilling or unable to extract significant long-term cost savings from providers. Healthcare providers seemingly feel the squeeze of “inadequate reimbursements” from insurers, but costs keep climbing, as do salaries and compensation.

This is where the “public option” comes in. The public option would be a single, nationwide health insurance plan that would be available as a choice for anyone who is currently uninsured, as well as many people with current coverage. It would co-exist with the current system of private health insurance, and no one would be forced to select the public plan. In fact, the only restrictions go in the other direction – public option advocates have agreed to restrict the ability of people with existing employer-based coverage to opt-in to the public plan in order to protect private insurers from the risk of losing too much business.

The public option plan can provide immediate savings to consumers who select it by doing away with some of the excess overhead consumed by insurance companies. There won’t be any premiums diverted to profits or outsized executive salaries. Moreover, government plans such as Medicare and Medicaid have proven to be more administratively efficient than their private counterparts. More importantly, a large public plan will bring competition and market discipline to every corner of the country. Frankly, the theory is that with enough enrollees, the public plan will be able to act as a price-setter, and not merely be a price-taker. The public plan will not be authorized to save money by rationing access to needed care.

Miracles of cost-containment, bringing us into parity with places like Canada should not be expected, but it’s very reasonable to expect that we can knock a couple of percentage points off the rate of annual medical inflation: What the President calls “bending the curve.” The savings would go beyond members of the public plan, as private insurers would be forced to respond with their own efficiencies. You wouldn’t know it from stories that cast the public option as yet another costly program demanded by “liberals,” but the public option is actually the most significant cost containment feature in the proposal being considered by Congress.

The latest polls on health care reform find that most Americans support it, but they are also confused about what is in the proposals currently being worked on by Congress. No wonder. The amount of misinformation floating around is enough to confuse a rocket scientist.

If the American public is feeling left out of the debate on health care reform, it just might have something to do with the $1.4 million per day being spent on lobbying this single issue by the drug, health insurance and other health-related industries. In addition, according to the Center for Responsive Politics, the health care industry has given members of Congress nearly $24 million in campaign contributions this year, on top of the $170 million they gave during the last election.

The drug manufacturers’ trade association, known as PHARMA, has spent more than $92 million lobbying Congress this year and is about to roll out a $150 million ad campaign to cut the discounts on drug products that are being planned to help reduce spiraling health care costs. Having enjoyed the largess of the Bush years, these companies are willing to spend big to keep their profits flowing.

Looking just at the committees that have jurisdiction over drafting the proposals that will go to the full Senate, the health care industry has given in excess of $13 million to the members of the Senate Finance Committee and more than $6 million to the “Gang of Six” who have been working over the summer on the Baucus proposal. As might be expected, the most money -- about $3.6 million -- is roughly split between Senator Baucus and the top Republican on the Senate Finance Committee, Senator Chuck Grassley.

When the Medicare Part D legislation was before Congress, an equally obscene amount of money was thrown at the negotiators who then somehow came up with a program that pays drug companies money to run private money-making programs to help seniors buy their products.

Polls show that most Americans support health care reform that includes universal coverage, some kind of nonprofit option, and paying for the changes with increased taxes on high income Americans and employer contributions.

Most Americans understand that when 46 million of their neighbors do not have health insurance and more are losing their health coverage every day, and when a health insurance crisis is the No. 1 reason for bankruptcy filings, that health reform is needed now. Most people agree we need regulations to make insurance companies play fair and cover people with existing conditions, and that the goal should be universal coverage – especially for children. Most people would like to keep the coverage they have but are afraid that, if costs keep going up, no middle class families will be able to afford private insurance coverage that would meet their needs. So, most Americans support tax credits and subsidies that will enable working families who really cannot afford health coverage to get it.

People are very confused about the public option, and fear it will take away from what they have, rather than make the kind of coverage Congress gets, available to everybody. This might have something to do with private health insurance companies’ fear that the competition from a public option might force them to cut administrative costs and shareholder profits.

It’s time to take back our government from the Big Money interests who are muddying the waters of the current debate. We have an out-of-control system now and the companies who are benefiting financially would like to keep it that way, so they are spending a lot of money to kill reforms Americans want, and need.--------------------------------------------------------------------------Evans is a Jackson health care activist and writer.--------------------------------------------------------------------------Copyright (C) 2009 by the Mississippi Forum 10/09

As our country's debate about health care reform gets lost in the obfuscation of partisan politics, I am thankful that Grady Health System is struggling to take care of its dialysis patients.

Don't misunderstand. I feel sorry for the dedicated leadership of Grady and its board, who, after decades of having nonpaying patients dumped on them by every other health system in town, is thoughtfully trying to find treatment alternatives for their patients.

But Grady, and its financial inability to continue providing life-sustaining treatment to its patients, epitomizes the failure of our current health system.

Inherent to reforming our health system is answering questions about who we are as a country and what are our values.

More specifically, do we as a country believe in health equity -- that everyone who lives in America has the right to health and access to health care? The inalienable rights to "life, liberty, and the pursuit of happiness" included in the Declaration of Independence would seem to include health. It is, after all, hard to live and be happy if you don't have access to opportunities for health.

Yet, at a recent town-hall meeting, to the cheers of her fellow health reform opponents, a woman asked "What makes you think because you wake up in the morning you have a right to health care?" In other words, just because you live and breathe doesn't give you any rights to health or health care.

Are those really our values?

Somewhere along the line, our independent, free market American culture decided that this most basic of rights -- the right to have good health and access to quality medical care -- is not a fundamental human right.

We have accepted as morally and ethically acceptable that, in our great country, there are tremendous health disparities. We accept that our friends, neighbors and family members are more likely to be diagnosed with late stage cancer, and die from it, if they are poor, uninsured, or a member of a racial or ethnic minority. We accept that they are more likely to die during pregnancy or have their infant die shortly after delivery if they are poor or African-American.

Do we as a caring nation really accept this?

To be honest, I'm quite confused. Because many of the opponents of health care reform are the same members of the so-called "pro-life" movement who cheered when President George Bush and the Congress intervened in the Terri Schiavo case in Florida. Is it ok for government, including the Congress and the president, to get involved in the decisions between a doctor and a patient when it promotes a political agenda, but otherwise, it shouldn't be involved?

Does "right to life" only apply to the unborn and those in persistent vegetative states? Are the Grady dialysis patients not entitled to the care they need to stay alive? Because our current system doesn't provide it, doesn't pay for it, and Grady can no longer afford it? So where is the moral indignation among those who are "pro-life" shouting out that for these patients and for our country, this is no longer acceptable?

Too many in the so-called debate about health care have forgotten what it is we are debating. It is a debate about the health and well-being of all of us. And it is also a debate about who we are as a nation; about our values and beliefs. As an American citizen and a physician, I believe we are long overdue in achieving the promise of health equity for everyone in our country.---------------------------------------------------------------------------Dr. Heiman is an Atlanta-based family physician and health policy analyst.---------------------------------------------------------------------------Copyright (C) 2009 by the Georgia Editorial Forum. 10/09

Access to health care for all seniors is important. Having a Medicare system that works? Crucial.

As we age, visits to doctors’ offices increase. Before President Johnson signed Medicare into law 44 years ago, many seniors lacked health care because of the cost. Imagine! But now, through Medicare, our federal government provides a valuable program for seniors and people with disabilities to improve their medical well-being. Coverage has helped reduce senior poverty by two-thirds.

Since 2003 and the implementation of the Medicare Modernization Act, Medicare Advantage plans (code for private insurance companies) have taken a toll on traditional Medicare. These Medicare Advantage plans are reimbursed at a higher rate than traditional Medicare, sometimes as much as 17 percent higher. This cost is being paid out of the traditional Medicare fund and is a strain on the Medicare budget. Passage of health-care reform will reduce this overpayment to private insurance companies, thereby easing any burden on working families' tax dollars.

In addition to cost savings in overpayments, meaningful reform will prohibit private-insurer discrimination against seniors with pre-existing conditions. Also, seniors will have more control when choosing providers.

The cost of prescription drugs, too, will go down. As things stand now, seniors on fixed or limited incomes often face agonizing either/or choices between high-priced medications and ever-increasing living expenses. True reform will provide more help for low-income seniors, more flexibility in changing drug plans and a closing of the dreaded donut hole – a gap in coverage that costs the average Medicare recipient thousands of dollars. All of these factors -- and the promise of no co-payments for Medicare preventive services such as check-ups and cancer screenings -- add up savings for all seniors and taxpayers.

There's more.

Meaningful reform should also bring savings to Medicare in the form of early Medicare enrollees. Persons age 55-64 (the pre-Medicare age group) should be allowed to buy-in to Medicare. More than 5 million Americans age 55-64 do not have health insurance. People in this age group should be able to see a doctor more often, especially for preventive care as this is the wrong time in your life to have to cut corners with your health. Through meaningful reform we can create an affordable way for them to buy in to Medicare coverage.

This early enrollment would allow people to seek medical care for their ailments. As of right now, these pre-Medicare people wait until they turn 65 and enter the Medicare system already ill. Sometimes, they have waited so long that their once easily treatable condition is now an expensive and life-threatening illness. An opportunity to buy-in at a younger age reduces the possibility of long term health care issues.

In fact, why not extend Medicare to everyone?

Medicare is a great American success story. Medicare for all would be a great American legacy.------------------------------------------------------------------------------Fransetta is president of Florida Alliance for Retired Americans.------------------------------------------------------------------------------Copyright (C) 2009 by the Florida Forum

A massive, historic and overwhelmingly positive change for women’s lives is coming our way, in the form of the health care proposals now being considered in the House and Senate.

While television networks and newspapers were recently full of commentary and reporting on Rep. Joe Wilson’s loud outburst, the quiet fact remains that when health care reform passes, more women and their families will have coverage than ever before in our nation’s history.

That is no small thing, in a country where an estimated 21 million women lack health insurance, where over half of all medical bankruptcies are filed by female-headed households, and where single mothers and young women dominate the ranks of the uninsured.

The pending reform of the American health care system will -- for the first time ever -- create a seamless, lifelong continuum of care for women, for whom the status quo health care system has been an abject failure.

For the first time, women will be able to participate in a health care system in which:

They won’t be charged more because of their gender;

Maternity and reproductive health will be part of a basic care package;

An affordability provision will subsidize those who can’t afford insurance;

The system will put a cap on out-of-pocket costs so families don’t go broke;

No American can be denied health coverage because of a pre-existing medical condition, including breast cancer, pregnancy or evidence of “uninsurability” such as being a victim of domestic violence; and Key preventative tests, like mammograms and pap smears, will be included in basic care.

The inclusion of women’s reproductive health in these plans is so critical to the health of America that the deans of 39 of America’s 50 schools of public health have endorsed a scientific, data-driven report stating that such treatments and services be part of any national health plan.

According to a report published by Columbia University’s Mailman School of Public Health, “a well-woman standard of care -- one that includes access to comprehensive care and services essential to reproductive health -- will ensure that women can attain good health, maintain it through their reproductive years and age well.”

This is good news for everyone -- not just women -- because the inability of the current system to adequately serve women’s health care needs has come at a staggering expense that is borne by everyone. One recent study estimates that women’s chronic disease conditions cost hundreds of billions of dollars. The direct costs of women’s cardiovascular disease, which impacts 43 million American women, are estimated at $162 billion annually. The direct medical costs of diabetes on women totals over $58 billion. The direct medical costs of osteoporosis, which impacts 8 million women, are estimated at nearly $14 billion annually. The direct medical costs of breast cancer are estimated at $9 billion.

Of course, it should surprise no one that any proposal that addresses women’s reproductive health comes with a vociferous debate on the subject of abortion coverage. The House Education and Labor Committee has effectively addressed this issue by adopting an “abortion neutrality” approach -- that is, by allowing private insurance plans to continue to decide whether to cover abortions (nearly 90 percent of them already do) and by maintaining existing restrictions on public funding for abortions. Onerous amendments that would have denied coverage even for private health insurance plans have already been defeated.

A number of national polls have shown that Americans strongly believe that health insurance should include the full range of women’s reproductive health services and that medical experts – not politicians -- should decide the details of a benefits package. The current bills in committee reflect that view.

By insuring coverage of prevention and basic health services like maternity benefits, the proposed reforms will create a system that provides health care, not just sick care, for women and ultimately all Americans.

That news may not be as exciting as a heckling Congressman -- not to mention a finger-chomping activist and gun-toting firebrands -- but it’s an enduring, important, positive change that will be with us long after the headlines have faded.------------------------------------------------------------------------Hall is the President and CEO of the Women Donors Network based in San Francisco, California.------------------------------------------------------------------------Copyright (C) 2009 by the American Forum. 10/09

Texas is home to world-class medical schools and institutions that are known far and wide for their state-of-the-art treatment and expertise. However, many Texans, and especially Texas women, do not have easy access to this remarkable resource.

Some of the health care reforms, now being considered in Congress, hold the key that will open the door. We can look forward to a world in which more women and their families have coverage than at any time in our nation’s history. In Texas, there has long been bipartisan, grassroots support for health care for women and children.

For Texas women, and the 21 million women across our nation without health insurance, that will be a truly life changing -- and in many cases, lifesaving -- moment.

Imagine a system in which, for the first time ever, women won’t be charged up to 45 percent more than men for identical coverage, and maternity and reproductive health will be part of a basic care package.

The reforms will also include coverage of important preventative tests like mammograms. And they will put a stop to the shameful practice of denying health coverage because of “pre-existing medical conditions” such as breast cancer and pregnancy, or evidence of “uninsurability” such as being a victim of domestic violence.

The inclusion of women’s health needs is so essential to the health of all Americans that the deans of 39 of America’s 50 schools of public health -- including the deans at University of North Texas and Texas A&M -- have endorsed a scientific, data-driven report by Columbia University’s Mailman School of Public Health stating that such treatments and services should be part of any national health plan.

According to the report, “a well-woman standard of care -- one that includes access to comprehensive care and services essential to reproductive health -- will ensure that women can attain good health, maintain it through their reproductive years, and age well.”

By ensuring coverage of prevention and basic health services like maternity benefits, the proposed reforms will create a system that provides not just “sick care” but true health care for women and ultimately for all citizens of our nation.

In these tough economic times, such changes can’t come soon enough to Texas. According to a report released recently by Families USA, a nonpartisan consumer advocacy group, family health care premiums for Texas workers rose about four and a half times faster than earnings from 2000 through 2009. That troubling figure may help explain why Texas also has the highest number of residents in the nation lacking health coverage (26.3 percent).

In fact, according to an analysis of U.S. Census data by experts at Baylor University, the counties with the six largest Texas cities ranked the worst in the nation in terms of working-age people without insurance. Houston’s Harris County tops the list with 37.6 percent of working-age adults under 65 lacking health coverage. Dallas County is a close second with 33.3 percent uninsured. Bexar, Travis, Tarrant and El Paso counties don’t fare much better.

Texas has the infrastructure, the innovation and the expertise to provide top-quality care for all of its citizens. Now all that’s needed is for our elected officials to help Texas live up to its world-class reputation for cutting-edge medical care by ensuring that Texans have affordable access to that care. In doing so, they will be making history for women and putting the keys to good health into the hands of all Americans.------------------------------------------------------------------------------Loeb, a member of the Women Donors Network and on the steering committee of their "Moving Forward" initiative on reproductive and other health issues, lives in Victoria. Miller, president/CEO of Texas Health Institute, lives in Austin.------------------------------------------------------------------------------Copyright (C) 2009 by the Texas Lone Star Forum. 10/09

Access to abortion is being used to hijack legitimate debate about the scope and type of health care reform.

While it’s true that abortion is a complex issue that brings out strong emotions from all ends of the spectrum, it’s important to remember that abortion is just one aspect of the full range of reproductive health care services a woman may seek throughout her lifetime. This headline-grabbing focus on the “a-word” means opportunities to use health care reform to increase access to and use of other vital reproductive services could be lost to political gamesmanship.

Take, for example, gaps for those women who choose to carry their pregnancies to term. In 2007, the National Women's Law Center ranked Colorado 42nd overall when it came to women receiving adequate prenatal care. Research has tied inadequate prenatal care to premature and low-weight births -- which in turn can lead to children exhibiting behavioral and developmental problems.

How can health care reform address this gap? We know that some insurance companies consider pregnancy a pre-existing condition -- grounds to deny coverage. In addition, rates for some insurance plans are based on gender; as a result, women get charged more for the same coverage as men their age even though pregnancy usually isn’t covered in these plans. Because of these practices, women face financial hurdles in obtaining the prenatal care they need to have a healthy pregnancy and to deliver a healthy baby. There’s clearly room for improvement in just those aspects of the health care system.

We also know that inadequate prenatal care can be a consequence of unintended pregnancy. In an ideal world, women would get pregnant only when they're ready to become parents. However, four out of every 10 babies born in Colorado are the result of unintended pregnancies. Why does this matter? Simply put, unintended pregnancies have serious consequences for women, their families, and their communities.

Research has shown that children of unintended pregnancies are at greater risk of being abused or neglected. We also know that women facing unintended pregnancies risk not completing high school and/or forgoing higher education. As a result, they have fewer employment opportunities and are more susceptible to perpetuating cycles of poverty where they find themselves dependent on taxpayer-funded welfare programs.

In today’s economic climate, unintended pregnancy has distinct financial ramifications for publicly funded programs like Medicaid, which paid for nearly 40 percent of all births in Colorado in 2003 to the tune of $261 million. The state is facing a $320 million shortfall in the 2009-10 budget. Imagine which programs and services -- whether public universities, DMV offices, mental health facilities, or prisons -- could avoid cuts if taxpayers weren’t paying for costs related to unintended pregnancies.

Over the last three years, the NARAL Pro-Choice Colorado Foundation has carried out research to understand barriers to preventing unintended pregnancy. Working through the Prevention First Colorado Coalition, we explored barriers and challenges women face in using contraceptives consistently and correctly when they do not want to become pregnant.

The research produced a number of findings, including identifying populations of women most at-risk to experience unintended pregnancy. Women living in rural or small-town communities, for example, compared to urban counties, had higher rates of births to girls aged 15 to 17, unintended pregnancy, and inadequate prenatal care.

Our research also revealed that regardless of the type of insurance a woman has, roughly half of women reported using contraceptive methods that are less effective as pregnancy prevention -- such as spermicidal foam or jelly, sponges, or condoms. Moreover, less than half of all women reported that they currently use a contraceptive method typically covered by insurance.

Those and other findings reveal a need to look for opportunities for systemic changes to prevent unintended pregnancy when reforming our health care system. At the top of the priority list should be a declaration that unintended pregnancy is a public health priority that affects all Colorado families and communities. By doing so, Colorado can make coordinated, strategic strides toward reducing not only unintended pregnancy, but also the need for abortion, infant mortality rates, disparities in health care access, and taxpayer coverage of avoidable health care expenditures.

It’s time to stop letting divisive rhetoric around abortion preclude necessary conversations about the need for sound policies to reduce unintended pregnancy, promote education, and improve access to birth control and prenatal care.-----------------------------------------------------------------------------Ailts is executive director of Denver-based NARAL Pro-Choice Colorado.-----------------------------------------------------------------------------Copyright (C) 2009 by the Colorado Editorial Forum. 9/09

Kids returning to school might find their lessons haven’t changed all that much from last year. That includes their school-sponsored sex education classes. Even though last spring President Obama ended federal funding for abstinence-only-until-marriage programs -- many of which were proven ineffective in delaying sexual activity – not much has changed yet in Georgia.

During the last school year, I spoke at numerous presentations at my high school to raise awareness about HIV/AIDS. I was repeatedly shocked at how little my fellow classmates knew about HIV/AIDS. I was asked on more than one occasion if HIV is transmitted by simple skin to skin contact. Before doing the presentations, I assumed that the students would know the majority of the information I was giving them. I was wrong.

Students repeatedly asked me about the effectiveness of condoms as protection against HIV infection. Unfortunately, I was unable to answer these curious students because school policy prohibited it. My school employed an abstinence-only policy, which extremely hindered me in giving potentially life-saving information to my classmates. On one occasion, one student confronted me during my presentation when I talked about abstinence and not about condoms. It was difficult for me to continue doing presentations after that incident because I whole heartedly agreed with him.

As a senior in high school I joined the Teen Action Group (TAG) -- Planned Parenthood's teen peer health educators -- because I wanted to empower myself and my fellow teens on matters of sexual health. Now, I see first-hand how responsive teens are to complete and accurate information. Young people are thirsty for knowledge and recognize how important this information is to their lives. I have seen how well teens respond to messages from other teens, often even better than they do with adult educators. For many of my peers who have only had ineffective programs in their schools, I am thankful that peer educators like me and the TAG group will continue to be sources of good information in our communities.

The goal of this program is to educate young people about delaying sexual activity, good decision making skill and contraception as a way of reducing the number of teen pregnancies in our state. Georgia has the 10th highest teen pregnancy rate in the nation and according to Advocates for Youth, the U.S. "continues to have the highest adolescent pregnancy and birth rates in the industrialized world, although U.S. teens initiate sex at about the same time as their European counterparts." The teen pregnancy rate in Canada is half of that in the U.S. With many teen parents and their children facing significant challenges for the rest of their lives, something more has to be done.

So, I have a few messages from myself and my fellow peer educators. To our parents: we understand why you would prefer that we wait to become sexually active until we're ready to be safe. We understand that the decisions we make now can affect the rest of our lives. We want to know what your feelings are about sex and relationships and we know that sometimes, it can be uncomfortable to talk about it. To schools and policy makers: providing us with 'abstinence-only-until-marriage' programs limits our decision making abilities. Withholding information about safer sex and contraception could put our lives at risk.

President Obama’s actions make it so now funds can only be used for scientifically based programs. This is great news for the next generation of young people. Georgia-schools now just need to implement changes to their programs.

Comprehensive sex education does not send a mixed message to us. We want to discuss the benefits of waiting to become sexually active as well as the ways we can be safe when we do become sexually active. Knowledge is power and by refusing us comprehensive sex education, you are depriving us of the power over our lives and our futures.--------------------------------------------------------------------------------McNulty, age 19, is recent Atlanta-area high school grad and a peer health educator through Planned Parenthood’s Teen Action Group program.--------------------------------------------------------------------------------Copyright (C) 2009 by Georgia Forum. 9/09